Catheter ablation (ab-LA-shun) is a medical
procedure used to treat some
arrhythmias
(ah-RITH-me-ahs). An arrhythmia is a problem with the speed or rhythm of the
heartbeat.
During catheter ablation, a long, thin, flexible
tube is put into a blood vessel in your arm, groin (upper thigh), or neck. This
tube is called an ablation catheter. Its then guided to your heart
through the blood vessel. A special machine sends energy through the catheter
to your heart. This energy finds and destroys small areas of heart tissue where
abnormal heartbeats may cause an arrhythmia to start.
Overview
The hearts electrical system controls the
speed and rhythm of your heartbeat. With each heartbeat, an electrical signal
spreads from the top of the heart to the bottom. As it travels, the electrical
signal causes the heart to contract and pump blood.
The process repeats with each new heartbeat. A
problem with any part of this process can cause an arrhythmia. (For more
information about the heart's electrical system, go to the Diseases and
Conditions Index article on
How
the Heart Works.)
Catheter ablation is one of several treatments for
arrhythmia. Your doctor may recommend it if:
The medicines you take dont control your
arrhythmia.
You cant tolerate the medicines your doctor
has prescribed for your arrhythmia.
Though few, catheter ablation has risks. These
include bleeding, infection, and pain where the catheter is inserted. More
serious problems include blood clots and puncture of the heart. Your doctor
will explain the risks to you.
Cardiologists (doctors who specialize in treating
people with heart problems) sometimes perform ablation through open-heart
surgery. But this method isnt as common as catheter ablation, which
doesnt require surgery to open the chest cavity.
Outlook
Catheter ablation alone doesnt always restore
a normal heart rate and rhythm. Other treatments may need to be used as well.
Also, some people who have the procedure may need to have it done again. This
can happen when the first procedure doesnt fully correct the problem.
Other Names for Catheter Ablation
Ablation
Cardiac ablation
Cardiac catheter ablation
Radiofrequency ablation
Catheter cryoblation
Who Needs Catheter Ablation?
Your doctor may recommend catheter ablation if:
You have an
arrhythmia
that medicine cant control.
You cant tolerate the medicines your doctor
has prescribed for your arrhythmia.
You have abnormal electrical activity in your
heart that raises your risk for ventricular fibrillation (a life-threatening
arrhythmia) and
sudden
cardiac arrest.
What To Expect Before Catheter Ablation
Before having catheter ablation, discuss with your
doctor:
How to prepare for the procedure, including
limits on eating and drinking. You will likely need to stop eating and drinking
by midnight before the procedure. Your doctor will give you specific
instructions.
Any medicines you're taking, and whether you
should stop taking them before the procedure.
Whether you have diabetes, kidney disease, or
other conditions that may require taking extra steps during or after the
procedure to avoid complications.
Some people go home the same day as the procedure.
Others need to stay overnight for 1 or more days. Driving after the procedure
may not be safe. Your doctor will let you know if you need to arrange for
someone to drive you home.
What To Expect During Catheter Ablation
Catheter ablation is done in a hospital. Doctors who
do this procedure have special training in cardiac electrophysiology (the
electrical system of the heart) and ablation (destruction) of diseased heart
tissue.
At the Start
Before the procedure, you're given medicine through
an intravenous (IV) line inserted in a vein in your arm. The medicine will help
you relax. It may make you sleepy. You're also connected to several machines
that check your heart's activity during the procedure.
Once you're drowsy, your doctor numbs an area on
your arm, groin (upper thigh), or neck. A needle is used to make a small hole
through the skin into a blood vessel. Your doctor puts a tapered tube called a
sheath through this hole.
Your doctor then puts a thin, flexible wire and an
ablation catheter (a long, thin, flexible tube) through the sheath and into
your blood vessel. The guide wire is threaded through your blood vessel to your
heart. The wire helps your doctor place the catheter correctly.
Then, your doctor puts a special dye into the
catheter. The dye makes the inside of your heart show up on special x-ray
images called angiograms. The images help your doctor place the tip of the
catheter in the correct spot in the heart.
During the Procedure
Electrodes at the end of the catheter are used to
stimulate the heart and record its electrical activity. This helps your doctor
learn where abnormal heartbeats are starting in your heart.
Your doctor aims the tip of the catheter at the
small area of heart tissue where the abnormal heartbeats are starting. A
special machine sends energy through the catheter to create a scar line, also
called an ablation line. The types of energy used include radiofrequency (heat
generated by electrodes), laser, or cryo- (very cold temperatures).
The scar line creates a barrier between the damaged
heart tissue and the surrounding healthy heart tissue. This stops abnormal
electrical signals from traveling to the rest of the heart and causing
arrhythmias.
The animation below shows catheter ablation. Click
the "start" button to play the animation. Written and spoken explanations are
provided with each frame. Use the buttons in the lower right corner to pause,
restart, or replay the animation, or use the scroll bar below the buttons to
move through the frames.
The animation shows an ablation
catheter inserted into the heart. This catheter is used to destroy, or ablate,
a small part of the heart muscle that's causing arrhythmias. The process allows
the heart to return to its normal rhythm.
What You May Feel
You may sleep on and off during the procedure. You
generally will not feel anything except for:
A burning sensation when the doctor injects
medicine into the area where the catheter will be inserted
Discomfort or burning in your chest when the
energy is applied
A faster heartbeat during studies of your heart's
electrical system
The procedure lasts 3 to 6 hours. When the procedure
is done, your doctor will pull back the ablation catheter and take it out along
with the sheath and guide wire.
The opening left in the blood vessel is closed and
bandaged. Nurses apply pressure to this site to help prevent major bleeding and
to help the site begin to heal.
What To Expect After Catheter Ablation
After the procedure, you're moved to a special care
unit where you lie still for 4 to 6 hours of recovery. Lying still prevents
bleeding at the site where the catheter was inserted.
While you're in the special care unit, you're
connected to special devices that measure your heart's electrical activity and
blood pressure. The nurses check these monitors continuously. Nurses also check
to make sure that there's no bleeding at the catheter insertion site.
Going Home
Your doctor determines whether you need to stay
overnight in the hospital. Some people go home the same day. Others need to
stay overnight for 1 or more days.
Before you go home, your doctor will tell you:
Which medicines you need to take
How much physical activity you can do
How to care for the area where the catheter was
inserted
When to see the doctor again
Driving after the procedure may not be safe. Your
doctor will let you know if you need to arrange for someone to drive you
home.
Recovery and Recuperation
Recovery from catheter ablation is usually quick.
You may feel stiff and achy from lying still for 4 to 6 hours after the
procedure. In addition, a small bruise may form at the site where the ablation
catheter was inserted. The area may feel sore or tender for about a week. Most
people are able to return to normal activity in a few days.
Talk to your doctor about signs and symptoms to
watch for. Let your doctor know if you have problems such as:
A constant or large amount of bleeding at the
catheter insertion site that you cant stop with a small bandage
Unusual pain, swelling, redness, or other signs
of infection at or near the catheter insertion site
Strong, rapid, or other irregular heartbeats
Fainting
What Are the Risks of Catheter Ablation?
Though few, catheter ablation does have risks.
Possible problems are:
Bleeding, infection, and pain where the catheter
was inserted.
Damage to blood vessels. This complication is
very rare. It's caused by the catheter scraping or poking a hole in a blood
vessel as it's guided to the heart.
Puncture of the heart.
Damage to the heart's electrical system. This may
lead to the need for a permanent
pacemaker.
A pacemaker is a small device that's placed under the skin of your chest or
abdomen to help control abnormal heart rhythms.
Blood clots, which could lead to stroke or other
damage.
Narrowing of the veins that carry blood from the
lungs to the heart. This is called stenosis.
As with any heart procedure, complications can
sometimes, although rarely, be fatal. The risk of complications is higher if
you have diabetes or kidney disease. It also is higher if you're 75 years old
or older.
Key Points
Catheter ablation is a medical procedure used to
treat some cardiac
arrhythmias
(irregular heartbeats). It's one of several treatments for arrhythmia.
Your doctor may recommend catheter ablation:
To treat your arrhythmia if medicine
doesnt help or if you cant tolerate the medicine.
If you have certain types of arrhythmia, such
as Wolff-Parkinson-White syndrome or some forms of
atrial
fibrillation.
If you have abnormal electrical activity in
your heart that increases your risk for ventricular fibrillation (a
life-threatening arrhythmia) and
sudden
cardiac arrest.
Catheter ablation alone doesnt always
restore a normal heart rhythm. Other treatments may be needed as well. Also,
some people who have the procedure may need to have it done again. This can
happen when the first procedure doesnt fully correct the problem.
Your doctor can tell you how to prepare for the
procedure.
Catheter ablation is done in a hospital. Doctors
who do this procedure have special training in cardiac electrophysiology (the
electrical system of the heart) and ablation (destruction) of diseased heart
tissue.
During the procedure, your doctor uses a long,
thin, flexible tube called an ablation catheter to find the area where abnormal
heartbeats are starting. Then, with the tip of the catheter, the doctor uses
one of several energy forms to find and destroy this tiny area.
The procedure lasts 3 to 6 hours.
After the procedure, you will need to lie still
for 4 to 6 hours. Some people are able to go home the same day. Others need to
stay overnight for 1 or more days.
Recovery is usually quick. Most people return to
normal activity in a few days. Talk to your doctor about signs and symptoms to
watch for. Let your doctor know if you have a large amount of bleeding at the
catheter insertion site or pain, swelling, redness, or other signs of
infection.
Though few, catheter ablation does have risks.
Some possible complications are bleeding, infection, and pain where the
catheter was inserted. More serious problems are blood clots and puncture of
the heart.